|The role of BAL in patients with Systemic scleroderma interstitial lung diseases (ILD) is controversial and in evolution. When a cell count is done on BAL from patients with SSc associated ILD, elevated numbers of granulocytes may be seen, especially neutrophils and eosinophils. Increased numbers of lymphocytes and mast cells may also be seen]. Early studies correlated increased granulocytes in BAL with increased response to immunosuppression presumably because this represented active alveolitis]. Subsequently, BAL granulocytosis has been shown to correlate with the degree of ground glass opacity seen on HRCT and with more advanced interstitial disease]. However, data from the Scleroderma Lung Study suggest that BAL granulocytosis does not add any additional prognostic information to HRCT and pulmonary function measures and is not a predictor of treatment response. There is no question that BAL is an important test in the consideration of infection.
Interstitial Lung Disease in Systemic Sclerosis: Diagnosis and Management
Respiratory medicine articles: Mary Beth Scholand, Elisabeth Carr, Tracy Frech, Nathan Hatton, Boaz Markewitz and Allen Sawitzke